FILLERS

About

FACE

FILLERS

Type of anaesthetic
None/ topical or local anaesthetic
Length of procedure
10-20 minutes
Recovery
Minimal to a few days (depends on area)

Onset of action
Immediate
Duration of effect
6 months to 1 year 
(depends on product & area)

FILLERS


  • INTRODUCTION

    Dermal fillers are used to ‘plump out’ lines, folds, and wrinkles of the face. They are most effective for static lines – that is ones that are apparent when the face is at rest. Most commonly, they are used for lines in the lower half of the face, with botulinum toxin injections being the first choice for lines in the upper face. Having said that, these two treatments can offer excellent results in both the upper and lower face, used either individually, or in carefully-tailored combinations. Fillers may also be used to enhance the lips, and to improve skin texture and quality.


    Many people shy away from the idea of fillers. They have seen examples of “trout pouts”, “pillow cheeks”, or other unnatural results. These results may occur as a result of using too much filler, or putting it in the wrong place. Other adverse results are associated with the use of old-fashioned collagen injections (which had a relatively high rate of allergic reactions), or the use of permanent fillers. I do not use such products. All the fillers I use are hyaluronic acid (HA) based. HA is a naturally-occuring substance in our bodies, and a synthetically-manufactured version is used in dermal fillers. The products I use are FDA-approved, with an excellent safety profile. The effects can be expected to last between six months (in more dynamic areas such as around the mouth), to a year and sometimes longer. Should a patient wish to get rid of the filler before then, it can usually be dissolved away with a relatively straightforward injection. You can read more about removal of fillers here: http://www.fitzgeraldplasticsurgery.ie/facial-plastic-surgery/fillers/

  • MY APPROACH

    My goal is always to provide a subtle, natural result, which enhances your facial features and is specifically tailored to your treatment goals. I carefully analyse your face, looking at any pre-existing imbalances, your skin quality and underlying bone structure. I take into careful consideration your specific treatment goals, bearing in mind that most Irish patients prefer to avoid an obviously “done” look. I will explain to you my preferred treatment plan, and most importantly, make sure you understand why I am taking the approach I suggest. My mantra, particularly on your first treatment, is to always err on the side of caution. I want us both to be delighted with the result, and will always take the time to ensure we are both ‘singing from the same hymn sheet’ when it comes to goals and expectations.


    I consider that one of the reasons that people are disappointed with the results of fillers is because they are used inappropriately – the wrong volume or placement used, or on occasion, because they are asked to do more than they are capable of. As a plastic surgeon, who can offer the full spectum of facial revitalisation treatments and procedures, I will not recommend a filler when I know that it is not going to give you your desired result.


    Some patients do not like the idea of having a synthetic material, even one as safe as HA, injected into their face. For others, the cost and inconvenience of repeated treatments is off-putting. In these cases, a more permanent option using only your own tissue, is lipofilling, or injections of your own fat as a natural filler. You may read more about this procedure here.

  • THE TREATMENT

    Fillers are used to treat lines, wrinkles, and folds of the facial skin. Lines are not usually eradicated, but substantially softened. They can also be used for lip augmentation, outlining, and in the treatment of fine lines around the lips and mouth. Courses of fillers may be used to improve the skin quality of areas such as the décolletage, cheeks, and hands. Volume in the cheek and chin area may be augmented through the use of fillers. More unusual treatments are smoothing of minor lumps or bumps on the nose (such as may occur following trauma or surgery). We will discuss whether fillers are the appropriate treatment to fulfill your goals at the time of your initial consultation.


    For many of the filler procedures we perform, no local anaesthetic is necessary. For superficial lines, and the treatment of lips, pre-treatment numbing is required by some patients. In order to decrease the discomfort associated with the procedure, local anaesthetic may be used, either in the form of a cream or a simple injection (similar to that one would have at the dentist) in advance of the injections. The filler is then slowly and carefully placed into the desired area, via a number of injections. I encourage you to participate in this process, and will often have you look in a mirror as we go along.

  • CONSEQUENCES & LIMITATIONS

    Immediately following the treatment, you can expect some swelling and numbness. The lips are particularly prone to swelling, which may worsen over a couple of days before gradually settling. Unless otherwise instructed, you should refrain from massaging/ rubbing the area for 24 hours following treatment, and excess pressure (e.g. lying face-down on a massage table) should also be avoided. Some bruising may occur at the sites of injection, and for this reason (combined with the expected swelling), I advise you to have your treatment done a minimum of two weeks before any major event/ occasion on which you would be self-conscious of these side-effects.


    Allergic reactions to HA fillers are exceptionally rare. Very occasionally (1 in 20000 treatments), patients may experience a hypersensitivity reaction, characterised by redness, swelling, and itching. Even more rarely (1 in 65000 treatments), a granulomatous reaction at the injection site may occur. Mild superficial infections at the injection site are possible, although rare. I will discuss any and all concerns you may have in detail with you, prior to embarking on a course of treatment.


    The results from fillers are not permanent. As a general rule, they last somewhere between nine and 18 months, and somewhat less than that (max. six months) around the mouth. There is growing evidence that the presence of HA encourages your body to form new collagen in the sites that have been injected, and it is certainly true that patients who have had repeated treatments find that they can space their treatments further apart as time goes on, as the effect from each treatment is more sustained.


    For general aftercare advice for dermal and lip fillers, please see here.

  • COMPLIMENTARY SKIN HEALTH CONSULTATION

    All patients undergoing an injectable treatment (botulinum toxin or fillers) at Fitzgerald Plastic Surgery, are invited to attend for a complimentary skin health consultation, with our aesthetic nurse. During the consultation, you will have an opportunity to discuss your current skin health regime, and look at what changes you could consider to improve your results. You are also welcome to discuss any of our Medispa treatments that may be of interest, and if appropriate, a laser/ IPL patch test can be performed. There is no obligation to purchase any product or service.

    To avail of the complimentary consultation, the appointment must take place within four weeks of your injectable treatment. 

  • AFTERCARE ADVICE

    Our guide to getting the safest and best results from your treatment


    What are fillers?

    Dermal fillers are composed of a clear gel, known as hyaluronic acid (HA). HA is naturally occurring and abundantly present within our bodies. It is a very hydrophilic, or water-loving molecule, which accounts for its ability to give plumping and hydration to tissues. The molecules of HA are stuck to each other during the manufacturing process, and the number and type of bonds between the molecules determines how stiff, thick, or pliable a particular filler is. Stiffer fillers are best used deep in the tissues, for volumising, while softer and more pliable formulations may be used in more mobile areas such as the lips. The softest formulations do not create any volume, but are used to deeply hydrate the skin from within. Selection of the correct filler is paramount to achieving the desired result. At Fitzgerald plastic surgery, only FDA-approved fillers are used: these are the highest quality products on the market, and the ones which have been tested most rigorously for safety.


    Who does the treatments?

    At Fitzgerald Plastic Surgery, all dermal and lip filler treatments are performed by consultant plastic surgeon, Ms Éilís Fitzgerald.


    Why does it matter who does the treatment?

    Dermal fillers are classified as a medical device, which unfortunately means that they are not subject to the same controls as prescription medications. As hard as it is to believe, the current situation in Ireland it that it is entirely legal for individuals with no medical training whatsoever, to purchase and inject these products. This is a potentially very dangerous situation, as the injecting individual has no medical knowledge or expertise to recognise or to treat complications from the treatment. In addition, they have no recognised training in anatomy or facial aesthetics, that would permit them to perform these treatments correctly. Such individuals cannot legally inject the substance which is used to dissolve fillers, as it is a prescription medication, which can only be administered by doctors. The ability to dissolve filler immediately should a problem arise is an essential part of being able to safely perform these procedures for people.


    While these products and treatments are very safe, there are certain risks associated with treatment. They also need to be placed in such a manner that respects natural anatomy, and facial aesthetic principles. Plastic surgery and dermatology are the only recognised specialities in which doctors are taught these principles over the course of many years. This level of training simply cannot be matched by doctors from other specialities (and none), who complete as little as a one day training course before terming themselves “cosmetic doctors” or similar. Please beware and be aware of who is doing your treatment. Ensure your doctor is on the Irish Medical Council’s Specialist Register in either Plastic, Reconstructive & Aesthetic Surgery (as Ms Fitzgerald is), or in Dermatology.


    Only a fully qualified plastic surgery consultant such as Ms Fitzgerald, or a consultant dermatologist, has undergone the years of training in respect of the anatomy and aesthetics of the face, to permit these treatments to be performed with maximum efficacy and safety.


    Preparing for your treatment

    Certain medications make you more prone to bleeding and bruising; these include aspirin, ibuprofen, Difene, and other NSAIDs (non-steroidal anti-inflammatories). Please do not take them for a week before treatment.

    If you are on any prescription blood-thinners, including aspirin, warfarin, plavix, Eliquis, Pradaxa, etc., you must check with the prescribing doctor if it is safe for you to stop these medications for treatment. If you are advised against stopping your medication, please do not do so. This may mean you are unsuitable for filler treatment. Please contact the office if you are unsure.

    If you take fish oils, evening primrose oil, high doses of vitamin C or E, St. John’s Wort, ginko, or ginseng, you should stop taking these a week before treatment, to reduce the risk of bruising.

    It you wish, you can take arnica by mouth for the week before and following your treatment, to reduce the chance of bruising.  Unfortunately, we cannot absolutely guarantee that bruising will not occur.  Please bear this in mind when planning the date of your appointment in relation to social events, etc.

    Avoid topical products such as Tretinoin (Retin-A), Retinols, Retinoids, Glycolic Acid, or any “Anti-Aging” products for 3 days prior

    Avoid waxing, bleaching, tweezing, or hair removal cream on the area to be treated for 3 days prior

    Do not drink alcoholic beverages for 24 hours prior to treatment

    If you have previously suffered from facial cold sores, there is a risk that the needle punctures could contribute to another eruption of cold sores. Please let the office know at the time of booking your appointment if you are prone to cold sores: you may require medication taken before your filler treatment, to reduce the risk of an outbreak.

    Dermal fillers are not suitable if you are pregnant, allergic to any of the ingredients, or have a diagnosis of certain neurological disorders. You will be asked to complete a screening health questionnaire in advance of your treatment. Should you have any questions, please just ask in advance of treatment.


    Day of treatment

    While many people choose to attend without any make-up on their face, your skin will be thoroughly cleansed before the procedure, so there is no need to come bare-faced if you do not wish to do so. You will be advised against applying foundation, etc., for several hours after the procedure. Eye make-up does not need to be removed.

    Should you wish to have numbing cream applied prior to your treatment, please be aware that you will need to attend up to an hour in advance of your scheduled appointment time with Ms Fitzgerald to have this applied. This is because it takes some time to be fully effective. Please ensure that you inform us of your requirements in this regard, as we cannot otherwise guarantee that adequate time will be available for application and efficacy of the cream.


    Immediately following treatment

    Immediately after the treatment, there may be redness, bruising, swelling, tenderness, and/or itching near the injection site.

    Please avoid itching , massaging, or picking around the injection site, unless you have been specifically instructed to massage the area.

    Swelling, redness, bruising, etc. is generally considered to be normal, and should subside rapidly within a few hours to a few days after treatment. This is normal and generally disappears within a few hours to a few days. If these symptoms last more than 3 days, please contact the office.

    We will provide you with an ice pack at the time of treatment. Many people find it useful to continue applying cool compresses at home afterwards (a bag of frozen peas works well). Arnica cream (available for purchase at the office), and/ or arnica tablets can help with bruising. Some people find the herbal supplement bromelain useful to help bruising resolve.

    You may take paracetemol to reduce any pain as necessary (not required in most cases).


    For the rest of the day

    Avoid any activity that makes you become red in the face – be that strenuous exercise, a sauna, or a warm environment. Yoga-lovers should avoid inverted poses. This is to prevent additional bruising. Wait until all swelling and redness have resolved before going back to these sorts of activities.

    Avoid drinking alcohol.

    Apply topical arnica if you wish

    Avoid pressure to the treated area(s), other than massage as directed during your consultation.

    If there is a visible bump, you can massage the area.

    Sunscreen and make-up can be worn: be careful to avoid excess pressure or rubbing during removal of same.


    Additional aftercare instructions

    It is safe to fly from the day of treatment (although, if only to avoid yourself the stress of getting to the airport on time, we advise waiting until the next day)

    Contact us immediately if…

    You experience fever and/or chills

    If the area appears red, hot to the touch, and “angry” looking.

    You have severe pain or increasing pain

    You notice discoloured blotches in areas not injected or blanching (whiteness) of injected areas

    You notice new onset visual disturbance or loss

    If you are concerned, please do not email, but contact us by telephone on 015553777. Office hours are Tuesday to Friday, 9am to 5pm. If you have concerns outside of those hours, you may contact the Beacon Hospital on 012937535.


    How long do fillers last?

    Depending on the area injected, the product used, and previous or concurrent treatments, results can be expected to last from about six months (for lips and skin retexturing treatments) to 12-18 months for volume restoration.


    How can I enhance my result?

    Glowing healthy skin is, without question, the number one thing to enhance the result of any treatment. As part of our holistic approach to facial rejuvenation. We encourage all patients who undergo an injectable treatment with Ms Fitzgerald a complimentary skin health consultation with our expert aesthetic nurse.  This consultation can take place at any time in the four weeks following your injectable treatment and many people find it works well to schedule it in conjunction with their review appointment with Ms Fitzgerald.  We would be delighted to provide you with further information on request.


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